Audiology Follow-Up Note (Hearing Loss Management)

Date of Service: [Date]

Patient: [Patient name and identifiers]

Audiologist: [Name, credentials]

Reason for Visit: [Clinical question: routine monitoring / problem-focused; patient's stated concern if applicable]

Subjective

[Interval history since last audiology or ENT visit] (Summarize in narrative format. Include patient perception of hearing change [stable / improved / worsened], laterality [right / left / bilateral], onset characteristics [gradual / sudden with date if sudden], and functional impact on communication and activities.)

[Associated symptoms] (Include pertinent positives and negatives for tinnitus, aural fullness, otalgia, otorrhea, dizziness/vertigo, and neurologic symptoms as clinically relevant. Include interval noise exposure or ototoxic medication changes only when pertinent. Omit symptoms not discussed.)

[Hearing device use] (If patient uses devices, document perceived benefit, average daily wearing time, and any concerns. If device details unavailable, state explicitly. Omit section entirely if patient does not use hearing devices.)

Objective

Prior Data Reviewed: [Prior audiogram date(s) and source; other relevant diagnostics] (State "No prior audiogram available for comparison" if none.)

Otoscopy: Right: [findings] / Left: [findings] (Note any factors affecting test validity.)

Test Conditions: [Setting, reliability/validity, limiting factors if any]

Results:

• Pure-tone audiometry: [Air and bone conduction thresholds per ear; PTA; degree and configuration summary]
• Speech audiometry: [SRT and word recognition scores with presentation level per ear]
• Immittance: [Tympanometry type, acoustic reflexes per ear] (Include only if performed.)
• Other tests: [OAE / ABR / other with key outcomes] (Include only if performed.)

[Audiogram attached or referenced] (If typical components were not performed, document the reason.)

Assessment

[Diagnostic impression] (Provide type, degree, and configuration of hearing status per ear.)

[Comparison to prior testing] (Quantify changes in dB by frequency region; state whether changes represent true change versus test-retest variability.)

[Asymmetry analysis] (If present, document type of asymmetry, whether new or longstanding, red flags, and whether referral criteria are met with the specific criterion. Omit if no asymmetry.)

Problem List: [Problems with laterality, ordered by clinical priority]

Plan

• Monitoring: [Planned retest interval; criteria for earlier evaluation]
• Referrals: [ENT / imaging / PCP as indicated with rationale; specific referral criteria triggered] (Omit if none indicated.)
• Technology/Rehabilitation: [Hearing aid plan, assistive device recommendations, aural rehab referral as applicable] (Omit if not applicable.)
• Counseling Provided: [Topics discussed: results explanation, communication strategies, expectations; patient response and decision]
• Patient Instructions: [Red-flag warnings for urgent evaluation; next appointment]
• Report Distribution: [Recipients and method] (Omit if not applicable.)